The Enemy Within: AIDS in the Military

Worldwatch Live Online Discussion

Radhika Sarin: Staff Researcher

March 28, 2003 - 1:00pm EDT

Armies all over the world are threatened by a deadly enemy lurking within their own ranks: AIDS. Soldiers are among the most vulnerable to the disease, and in many countries HIV infection rates are several times higher in the military than among civilians. Senior military officials and national defense ministers are beginning to recognize this emerging security threat, but there are still considerable differences in how militaries are approaching such issues as HIV testing among soldiers.

Download Radhika's World Watch magazine article: The Enemy Within: AIDS in the Military

Steve Conklin, Worldwatch Institute: Welcome to this week's online chat with Worldwatch Staff Researcher Radhika Sarin. Radhika will be answering questions on her World Watch magazine article The Enemy Within: AIDS in the Military. Welcome, Radhika.

Radhika Sarin: Thanks, Steve! Glad to be here and have this discussion.

North Carolina: With HIv infection rates rising so rapidly in some countries, and even more-so within their military, what are ways that the 'snowball' effect of this epidemic can be slowed?

Radhika Sarin: We need a three-step approach. First of all, we need to continue prevention efforts. This includes education about how HIV is spread and how it can be prevented. Many national armies now provide this type of information to their soldiers as part of military training. One of the most successful cases is the Royal Thai Army, whose conscripts are mainly young men with little formal education. The Royal Thai Army has a very creative system to raise soldiers' awareness of HIV/AIDS, including role-plays and competitions. Second, condoms need to be promoted and provided to soldiers. The Cambodian army in fact markets a special brand of condoms to soldiers. And finally, treatment should be available to those who are already infected. Access to antiretrovirals can extended lives by many years, and, in fact, provides an incentive for people to get tested.

New York, NY: What are the expected repercussions of the current conflict in Iraq with regards to the spread of AIDS? Do you have figures on current rates of infection in Iraq, and are there projections of those rates increasing significantly during a US/UN occupation?

Radhika Sarin: UNAIDS estimates that less than 1,000 people are infected with HIV in Iraq. These estimates are for the end of 2001. Overall, Iraq's national prevalence rate is quite low, less than 0.1% of adults are infected. However, the actual number of infections could be higher than reported cases, as is often the case in many countries where the epidemic is young.

Conflict creates a situation in which infectious diseases, including HIV/AIDS, can spread very rapidly. Periods of conflict and immediate post-conflict are characterized by a breakdown in social services and health care availability. In addition, mass migrations and large numbers of internally displaced people can aid the transmission of HIV well. And, often displaced or impoverished women may turn to prostitution in order to obtain food or security.

New Jersey: Can you describe the ways in which AIDS is a threat to national security? Which is a larger threat: AIDS within military ranks, or AIDS creating instability within the general civilian population?

Radhika Sarin: There are a number of ways in which AIDS threatens national security. The spread of HIV/AIDS within the military can undermine combat readiness. In fact, the National Intelligence Council (an arm of the CIA) has warned that military capabilities could deteriorate if HIV spreads unchecked among soldiers. For nations that are already politically unstable, even the perception of a weakened military can make them susceptible to an internal coup d'etat or enemy attack. Many security analysts have also warned that soldiers' risk-taking increases when HIV/AIDS is rampant and access to treatment is low. Soldiers may loot and plunder in order to get money to buy treatment.
AIDS spreading in the general civilian population also creates instability and insecurity. The growing number of orphans due to AIDS, for example, presents a huge challenge to stability, as does the dramatic loss of workers, civil servants, and teachers.

Washington, DC: First of all, the article is comprehensive and excellent work. My question: Because military forces often represent essential underlying support for weak states, one would expect that those forces would receive preferential anti-retroviral therapy, despite its expense to developing countries. Do you know of any documented instances where military forces have obtained easy access to ARV therapy when civilians are left without it?

Radhika Sarin: This is a very good question. Because the military is often the single-most important institution in many African countries, those who serve in the military often have greater privilege, in terms of pay and social standing. And quite a few African militaries are committed to providing treatment for their soldiers, such as the Ugandan People's Defense Forces and Nigeria's Armed Forces. These militaries do try and work with military spouses and civilian communities to provide HIV prevention education. However, access to antiretrovirals is very low in many African nations.

Hilo HI: Considering we are now two to three times the planetary sustainable carrying capacity, isn't such an epidemic to be expected as a normal part of the natural system of checks and balances? Isn't the virus simply evolving to fill a void provided by the abundance? The military would certainly be a very effective way to disperse STD's over large areas.

Radhika Sarin: There are theories that HIV (and other infectious diseases, especially those that are re-emerging) spread to human populations as a result of increased contact with primates due to rapid deforestation or other forms of ecosystem change. However, the AIDS epidemic is hardly the solution to the problem of growing populations. In fact, AIDS is further destabilizing regions because it affects the most productive members of society. The latest population projections by the UN are grim in terms of future AIDS-related mortality. Global population projections for 2050 now take into account the death toll from AIDS.

Washington, D.C.: It never occured to me to think about AIDS as it relates to the military until I read recently about an attempt by the Zambian military to test its soldiers for AIDS. How can individuals and organizations lessen the stigma associated with AIDS? How can we actually get the numbers of who is infected? That just seems like a crucial step in combatting the disease.

Radhika Sarin: Yes, both Zambia and Russia recently announced that they would test military recruits for HIV now. Lack of comprehensive data on the numbers of soldiers infected remains one of the biggest challenges. Many militaries simply cannot afford to test their soldiers or provide the appropriate counselling that should go along with testing. One suggestion has been the creation of an international "military-to-military" network, whereby militaries such as the US Department of Defense can provide resources and training to their counterparts in poorer nations.

Eliminating stigma is also key. Stigma and discrimination are keep many people from coming forward and getting tested for HIV. And, if people don't know their HIV status, they are unlikely to change their behavior and protect their sexual partners. Uganda's army has a "Post-Test Club" which works with soldiers to promote openness and dialogue about the disease.

Albany, NY: With AIDS and HIV reaching such epidemic levels, and your research clearly showing that military organizations are not immune.... Has this sparked the creation of any new organizations who may help position the world to fight this problem?

Radhika Sarin: This recognition that HIV/AIDS is a security threat has sparked a lot of new partnerships. Traditional security groups are paying attention now to the AIDS epidemic and partnering with health organizations. I would say that a big step forward was in 2000 when the UN Security Council deliberated on this issue and passed Resolution 1308 calling for HIV education for international peacekeepers.

Recently several UN agencies, including the UN Population Fund (UNFPA), UNAIDS, and the Department of Peacekeeping Operations (DPKO) announced a joint initiative aimed at educating peacekeepers in Sierra Leone about HIV. The idea is that peacekeepers can become become change agents in the communities in which they serve, helping to spread awareness about the disease among civilian populations, especially uprooted or displaced people who are very vulnerable to HIV.

I see these kinds of partnerships as key to fighting the AIDS epidemic. The toll of the epidemic is so great that it requires a concerted effort on the part of many different sectors of society.

Washington, DC: As you mentioned, the U.S. Defense Dept. has maintained a small military-to-military program to build up military prevention programs in developing countries (particularly sub-Saharan Africa). But the funding is small (around $10 million) and the Defense Dept. really doesn't ask for the funding -- some AIDS-conscious Congressmen push it through (I heard Ms. Pelosi introduced the request in the current budget). It would seem that this effort would be essential to reduce HIV incidence in Africa. Why do you think "international HIV-prevention in the military" gets so little support, when it could be so successful?

Radhika Sarin: This gets at the issue of funding for global AIDS efforts. Overall, funding levels remain low across the board. I do think that as people (especially those in power) become more aware of the security ramifications of the AIDS epidemic, this funding will increase. One reason why funding remains low is because HIV/AIDS is a very political disease. Despite international concensus that efforts need to be taken on curbing its spread, the actual implementation stirs up a lot of debate. How much should be spent on prevention vs. treatment? What types of prevention methods should be promoted? Should the money be given to the UN's Global Fund to Fight AIDS, Tuberculosis and Malaria, or should funding be dispersed bilaterally?

Washington, DC: Hi. I wanted to know what measures are being taken with respect to international peacekeeping forces, which consist of several national military elements and have often been documented (though not publicly acknowledged) in assisting in the transmission of HIV/ AIDS in developing countries through their interactions with local communities they are meant to be guarding?

Radhika Sarin: Yes, peacekeeping forces in Sierra Leone and Cambodia have been linked with the spread of HIV/AIDS in those countries. Resolution 1308, which the Security Council adopted in 2000, catalyzed several changes. An AIDS Awareness Card was developed for peacekeepers. DPKO now provides several modules on HIV/AIDS as part of their training, including modules on risk assessment and behavior change. DPKO also provides each contingent with five condoms per person per week. Voluntary counseling and testing (VCT) is encouraged.

Sunnyvale, CA: Suppose HIV/AIDS testing reveals that a soldier is infected. What next? What is an appropriate and effective way of dealing with the situation? I would imagine that different countries would deal with the problem in very different ways depending on the resources etc. available. As you said, for example, access to ARV treatment is very limited in Africa. Do any developed countries have a coherent policy on this yet?

Radhika Sarin: Testing remains the most controversial of all health-related interventions. A military must take into account three sets of factors in choosing a testing policy: combat readiness, public health, and ethics. I can't go into all the details here, but my article provides these details. But you are correct that different militaries have different policies depending on their contexts and their resources. Testing is most common for new recruits, with recruitment being contingent upon testing negative. Testing is also common before soldiers are sent abroad to serve. Air force pilots might be tested because their tasks require more skill and stress. In Peru, for example, air force pilots who test positive are not allowed to fly.

With regard to ARV access, a large number of militaries are committed to providing treatment to their soldiers if they are found to be HIV-positive. However, militaries that lack the resources to do so may have more stringent testing policies and discharge soldiers that are tested positive. In Bangladesh and the Philippines, for example, HIV-positive soldiers are automatically discharged.

Steve Conklin, Worldwatch Institute: Thank you Radhika for joining us today and providing much needed information regarding HIV-AIDS and the military. Please join us next week with Worldwatch Researcher Danielle Nierenberg for a live discussion on mental health.

Radhika Sarin: Thanks to everyone who joined in the discussion today! If you haven't already read my article, you can find it on the Worldwatch website. It provides a detailed discussion of some of the topics we addressed today. Thanks, again!